Management of tuberculosis: are the practices homogeneous in high-income countries?

Objectives: to evaluate and compare practices regarding the diagnosis, isolation measures, and treatment of tuberculosis (TB) in high-income countries and mainly in Europe. Materials and Methods: a survey was conducted from November 2018 to April 2019 within the European Society of Clinical Microbiology and Infectious Diseases Study Group for Mycobacterial Infections (ESGMYC). The practices observed were compared to the main international guidelines. Results: among 136 ESGMYC members, 64 (17 countries) responded to the questionnaire. In their practice, two (20.7%) or three sputum samples (79.3%) were collected for the diagnosis of pulmonary TB, alternatively induced sputum (n = 37, 67.2%), bronchoscopy (34, 58.6%), and gastric aspirates (15, 25.9%). Nucleic acid amplification tests (NAATs) were performed by 41 (64%) respondents whatever the smear result and by 47 (73%) in case of smear-positive specimens. NAAT and adenosine deaminase measurement were used for extrapulmonary TB diagnosis in 83.6 and 40.4% of cases, respectively. For isolation duration, 21 respondents (42.9%) were keeping isolation until smear negativity. An initial treatment without ethambutol was offered by 14% (n = 9) of respondents. Corticosteroid therapy, cerebrospinal fluid opening pressure testing, and repeated lumbar puncture were carried out for central nervous system TB by 79.6, 51.9, and 46.3% of the respondents, respectively. For patients with human immunodeficiency virus-TB coinfection, the preferred antiretroviral therapy included dolutegravir 50 mg twice a day (56.8%). Comparing with the recommendations of the main guidelines, the practices are not totally consistent. Conclusion: this study shows heterogeneous practices, particularly for diagnosis, and isolation, although rapid molecular testing is implemented in most centers. More standardization might be needed

Carnobacterium divergens Bacteremia in Woman

International audienceTo the Editor: Carnobacterium spp. are ubiquitous lactic acid bacteria isolated from cold and temperate environments (1). They are present in food including fish, meat, and dairy products. Only C. divergens and C. maltaromaticum (formerly C. piscicola) are found in dairy products (2). Carnobacteria are well known for their ability to produce bacteriocins that inhibit Listeria monocytogenes (1). Because Carnobacterium and Listeria bacteria are psychrotrophic and share the same ecologic niche, many studies have highlighted the potential use of carnobacteria as a biopreservative (1). These bacteria were previously believed to be nonpathogenic for humans. We report a case of C. divergens bacteremia in a woman. [...

Pristinamycin for Rickettsia africae Infection

International audienceAfrican tick bite fever is caused by Rickettsia africae. The number of reported cases in international travelers has signifi cantly increased recently. 1 The gold standard treatment is doxycycline. Here, we present a case of R africae infection associated with quick complete resolution following the initiation of pristinamycin therapy

Use of Whole-Genome Sequencing to Explore Mycobacterium tuberculosis Complex Circulating in a Hotspot Department in France

The Seine-Saint-Denis is the French metropolitan department with the highest incidence of tuberculosis (TB). Our aim was to explore epidemiological and phylogenetic characteristics of TB strains in this hotspot department. We performed WGS on 227 strains of Mycobacterium tuberculosis complex isolated from patients at the Avicenne Hospital from 2016 to 2021 and randomly selected to represent the clinical diversity of French TB localization. Clinical and demographic data were recorded for each TB patient. The mean age of patients was 36 years old. They came from Africa (44%), Asia (27%), Europe (26%) and America (3%). Strains isolated from extrapulmonary samples were associated with Asian patients, whereas strains isolated from pulmonary samples were associated with European patients. We observed a high level of lineage diversity in line with the known worldwide diversity. Interestingly, lineage 3 was associated with lymph node TB. Additionally, the sensitivity of WGS for predicting resistance was 100% for rifampicin, isoniazid and ethambutol and 66.7% for pyrazinamide. The global concordance with drug-susceptibility testing using the phenotypic approach was 97%. In microbiology laboratories, WGS turns out to be an essential tool for better understanding local TB epidemiology, with direct access to circulating lineage identification and to drug susceptibilities to first- and second-line anti-TB drugs

Relevance of EORTC Criteria for the Diagnosis of Invasive Aspergillosis in HIV-Infected Patients, and Survival Trends Over a 20-Year Period in France

International audienceBACKGROUND: Before the advent of combination antiretroviral therapy (cART), roughly 50% of cases of invasive aspergillosis (IA) associated with human immunodeficiency virus (HIV) infection involved individuals without classical predisposing host factors, and the median survival time was \textless4 months after diagnosis. We examined if the situation evolved over time using the revised European Organisation for Research and Treatment of Cancer/National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC) definition and analyzed survival trends after diagnosis over 20 years. METHODS: A data review committee evaluated 342 medical records that mentioned IA in the French Hospital Database on HIV. Validated cases were classified as fulfilling the EORTC criteria or otherwise as "HIV-related IA." Three periods were analyzed: pre-cART (before 1996), cART era prevoriconazole (1996-2001), and 2002-2011. RESULTS: Among 242 validated cases of IA, 124 (51%) fulfilled the EORTC criteria (EORTC-IA) and 118 (49%) were classified as "HIV-related," with similarly low CD4 cell counts in both groups. The proportion of EORTC-IA cases remained stable across the 3 periods (50%, 48%, and 54%, respectively). The 3-month survival rate improved after the advent of cART (38% vs 69%), with no difference between EORTC-IA and HIV-related IA (hazard ratio [HR], 1.2 95% confidence interval [CI] \0.7-1.8\). Voriconazole exposure decreased mortality in 2002-2011 (HR, 0.1 95% CI [0.01-0.8]). CONCLUSIONS: In the cART era, EORTC criteria, developed for use in hematology/oncology, still applied to only half the cases diagnosed among HIV-infected patients. A rapid diagnosis of IA is paramount to improve survival. For patients who do not fulfill the EORTC definition, we suggest that the addition of "HIV infected with a CD4 count \textless100 cells/µL" to the EORTC host criteria be validate

Management and treatment of uncomplicated imported malaria in adults. Update of the French malaria clinical guidelines

International audienceThe diagnosis of malaria should always be considered in travelers returning from an endemic area and presenting with fever or a history of fever, either isolated or combined with other general, digestive, and/or respiratory symptoms, even if appropriate chemoprophylaxis was used.• Outpatient management of uncomplicated Plasmodium falciparum malaria may be implemented if precise clinical and biological criteria are met and if medical follow-up is possible.• Admission to hospital is recommended for individuals at risk of complications (young children and elderly, comorbidity, pregnancy, splenectomy, etc.).• The first-line treatment of uncomplicated P. falciparum malaria in adults is an artemisinin-derivative combination therapy (ACT): artemether-lumefantrine or artenimol-piperaquine. When such treatment is unavailable, not tolerated, or contraindicated, if interactions with concomitant medication are possible, or if ACT fails, then treatment with atovaquone-proguanil is an alternative option. Pregnant women (1st trimester) presenting with uncomplicated P. falciparum malaria should be hospitalized and treated with atovaquone-proguanil, or quinine if vomiting occurs. From the 2nd trimester on, priority should be given to artemether-lumefantrine or artenimol-piperaquine.• Uncomplicated malaria caused by species other than P. falciparum (i.e., P. vivax, P. ovale, P. malariae, or P. knowlesi) is treated with chloroquine or ACT. The latter is preferable in cases of co-infection or P. vivax malaria in travelers returning from a region known for resistance to chloroquine.• To prevent relapses in individuals infected with P. vivax or P. ovale, the dormant liver forms must be eliminated using primaquine, for which temporary use authorization (TUA) may be obtained once possible contraindications have been ruled out (glucose-6-phosphate dehydrogenase [G6PD] deficiency, pregnancy, breastfeeding)

Revised Definitions of Tuberculosis Resistance and Treatment Outcomes, France, 2006–2019

International audienc